Robotic partial nephrectomy: Renal function loss low in CKD patients

Patients with chronic kidney disease (CKD) who undergo robot-assisted partial nephrectomy for kidney cancer have minimal loss of renal function-a smaller amount even than patients with normal kidney function, according to researchers at Henry Ford Hospital in Detroit, who say their study is the largest of its kind.

The study, which included patient data from four additional centers, is published online ahead of print in European Urology (Dec. 14, 2013).

“Our study supports robot-assisted partial nephrectomy as an alternative to open surgery for patients with chronic kidney disease because decreases in kidney function after the procedure appear minimal,” said senior study author Craig Rogers, MD, of Henry Ford Hospital’s Vattikuti Urology Institute. “In addition, no patients developed end-stage kidney disease requiring long-term kidney dialysis.

“Our study shows that these patients can also receive the benefits of a minimally invasive robotic approach when performed by experienced surgeons, and they do well.”

All of the patients in the study underwent RPN, and all cases were performed by surgeons with extensive experience in the RPN operation. Other participating centers were Cleveland Clinic; Johns Hopkins, Baltimore; New York University; and the Washington University School of Medicine, St. Louis.

Data were collected from nearly 1,200 patients who underwent RPN between 2007 and 2012. Outcomes of patients who had pre-existing chronic kidney disease with decreased kidney function before surgery were compared against those with normal kidney function. Kidney function was measured according to each patient’s glomerular filtration rate.

Using propensity score matching, the researchers found that patients with chronic kidney disease had a lesser decline in kidney function after RPN than those with normal kidney function, when measured at their first follow-up exam and later visits. However, those with pre-existing chronic kidney disease had a higher risk of relatively low-grade surgical complications and a longer hospital stay.

In related news, Henry Ford researchers report that more children are undergoing minimally invasive surgery for diseased kidneys, with most of the procedures being performed at teaching hospitals to treat non-cancerous conditions.

Their conclusions were reached in a study published online in The Journal of Urology (Oct. 7, 2013), and suggest that as practitioners become more familiar with the techniques of minimally invasive nephrectomy (MIN) in children, it will be used more often to avoid the potential complications of traditional open surgery.

“At the time we began our research project, little was known about the usage of laparoscopic or robotic kidney removal in pediatric patients, although many studies have been done about minimally invasive kidney surgery in adults,” said senior author Jack S. Elder, MD. “As we expected, the use of MIN in children, like in the adult population, is on the rise.”

The researchers studied 27,615 U.S. pediatric kidney patients who underwent MIN or open nephrectomy (ON) between 1998 and 2010. Among the findings:

• Although there has been a significant increase in the use of MIN for pediatric patients, ON still accounts for more than 85% of their nephrectomies.

• Nephrectomy was most common in children from birth to 1 year of age (36%) and least common in children ages 6 to 9 years (14%).

• The majority of nephrectomies (73.8%) were for benign conditions, with only 2.2% percent of MIN procedures performed for malignancy.

• MIN usage to treat children increased from 1.1% to 11.6% over the study period.

• The overwhelming majority of pediatric nephrectomies are being performed at urban, academic medical centers.

Funding for the study was provided by the Vattikuti Foundation.

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